Outline

Rationale: Toxic epidermal necrolysis (TEN) is a rare potentially life-threatening and usually drug-induced skin disorder resulting in extensive mucocutaneous exfoliation and systemic involvement. At present there are no standard management guidelines but treatment should be multidisciplinary with prompt diagnosis, withdrawal of the suspected drug, supportive care and wound management in a Burn Unit.

At present there is no general agreement as to what is the most appropriate wound care material. SuprathelÂ® is a recently introduced epidermal skin substitute which has been used in partial-thickness burns as well as in split-thickness skin graft donor sites.

Allograft (cadaveric) skin is well recognised for its use in TEN as well as its versatility in burn patients in general.

We report our experience in the use of suprathel and allograft skin in a severe case of TEN.

Methods: A 17 year old female patient with TEN affecting 80% total body surface area (TBSA) was recently treated in our Burn Unit. Suprathel was applied circumferentially to the right upper and lower limbs and torso. Allograft skin was applied to the facial area and circumferentially to the left upper and lower limbs.

Results: SuprathelÂ® was easy to apply with good adherence. The allograft skin was more cumbersome and time-consuming to apply requiring staple fixation. There was reduced exudation in the SuprathelÂ® treated areas leading to fewer dressing changes and was consequently less painful. The SuprathelÂ® treated areas healed overall quicker (<12 days) than the allograft areas (14–21 days). The overall cosmetic appearance of the SuprathelÂ® healed skin was superior to the allograft healed skin. The facial areas treated with allograft were left with significant areas of allograft remnants.